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Just in Time for Lunar New Year, Another SARS-like Epidemic Is Brewing in China
Scores of people in Wuhan and Hong Kong have been sent to hospitals because of a mystery respiratory ailment—and true to form, China is trying to keep it quiet.
Here we go again.
A mysterious outbreak sickens people in China, causing panic in Hong Kong, Singapore, and Taiwan as the world awaits real information from Beijing. We have been here many times before, from deadly influenza epidemics in the 1990s to SARS in 2003, with more flus since and recently even a cluster of pneumonic plague cases.
This time around, the story begins with a mysterious respiratory outbreak on Dec. 12 in the central Chinese city of Wuhan. It sent at least 59 people to isolation wards in infectious diseases hospitals, where seven are now said to be in critical condition. As is typical, Beijing has kept mum about the outbreak, aside from insisting that the scientists—including non-Chinese—toiling to identify the culprit microorganism need to maintain secrecy and that there is no evidence that it can be spread from person to person. In fact, the government delayed notifying anybody about the pneumonia outbreak until Wuhan city officials acknowledged it two weeks after its apparent onset. In part because of the delay, the disease spread—according to some sources, there have been at least 16 suspected cases so far in restive Hong Kong and one putative case in Singapore—and Beijing has threatened to jail individuals who convey further information about the disease on social media.
The government of Chinese President Xi Jinping is doing itself no favors by handling outbreaks in such a brutal and secretive fashion. Regardless of whatever legitimate scientific inquiry may now be underway, the lack of transparency and domestic repression of so-called rumormongers simply fuel international suspicions of a cover-up, perhaps of a larger-than-admitted epidemic. Most of the news media worldwide has compared the Wuhan outbreak to the 2003 SARS (severe acute respiratory syndrome) epidemic, which spread from mainland China to nearly 30 nations, sickening upwards of 8,000 people, killing 774, and sowing panic around the world.
China would do well to remember the lessons of that outbreak—particularly the humiliation its leaders suffered from anger across Asia—and open the lid on daily information on the Wuhan pneumonia investigation. And it had better do so before Jan. 25, the Lunar New Year, when millions of Chinese pass through the nation’s high-speed train hub of Wuhan on their way to celebrate the holiday with relatives.
As of this writing, it seems that the new outbreak started in, or around, a very large indoor fish market in the city of Wuhan, which has a population of more than 11 million and is located south of Beijing in Hubei province. Whatever the precise origin, most of the subsequent infections have been in Wuhan. Two of China’s major rivers—the Yangtze and Han—flow through the city, making it one of China’s oldest and most important centers of commerce. It is also a hub in China’s vast high-speed railway system, which carries millions of passengers daily. In other words, the latest outbreak has not struck some remote outpost, as has been the case with other epidemics, including Ebola in the Democratic Republic of the Congo, but has arisen in a central hub in a country that is, itself, at the center of international trade and travel.
The Medical Administration of Wuhan Municipal Health Committee first raised the alarm on Dec. 30, when it posted a red alert on its website, declaring an “urgent notice on the treatment of pneumonia of unknown cause.” Local reporters who called the Health Committee hotline were merely told that there was a pneumonia outbreak of unknown cause involving 27 patients, most of whom were connected in some way to the South China Seafood Market. The patients exhibited respiratory distress, reduced white blood cell counts, and high fevers, and they failed to improve with antibiotic treatment. A viral cause was suspected.
On New Year’s Eve, Hubei provincial authorities put out a report announcing that an official inquiry concurred that “27 cases of viral pneumonia have been found, all of which were diagnosed with viral pneumonia/pulmonary infection. Of the 27 cases, seven were critically ill, and the remaining cases were controllable. Two of them improved and were expected to be discharged soon.”
That night, Hong Kong authorities began tightening security, acknowledging that three travelers who had been in Wuhan had ended up in hospitals in the territory suffering respiratory distress. One woman was being treated in Princess Margaret Hospital, which managed many of the 2003 SARS cases. Along with Hong Kong, Singapore and Taiwan also began conducting temperature screenings at airports and train stations, hoping to spot feverish pneumonia carriers before they could spread whatever the mysterious disease might be.
Then, on New Year’s Day, alleged medical documents appeared on Chinese social media and Twitter purporting to show that the outbreak was, in fact, caused by the SARS virus, which is a member of the coronavirus family. But by Jan. 3, Chinese authorities said they had ruled out several types of pneumonia, as well as SARS, noting that the mystery agent was not a coronavirus and bore less than 4 percent genetic similarity with SARS. Concern about another SARS epidemic was ill-placed, authorities said, and they arrested eight individuals from Wuhan, who now face severe punishments for “publishing false information on the internet without verification.”
David Paulk, editor of the Shanghai-based Sixth Tone news website, noted on a page that has since been removed that the crime of spreading rumors can lead to seven years’ imprisonment in China. Last year, a man was detained for 10 days for “spreading rumors” on WeChat about a H7N9 flu outbreak in Haikou. In 2018, a man went to prison for falsely claiming that thousands of people had been hospitalized after eating tainted watermelons.
The reason rumors spread so easily is clear. As Paulk translated one post that has since been removed on Weibo, “People spread rumors precisely because the authorities didn’t respond in a timely manner, so how can we be blamed? Don’t I have the right to know the truth, be afraid, and try to save myself?” Another person wrote, “How is this a rumor?” on the Wuhan police’s Weibo account, according to the South China Morning Post. “This outbreak happened. The public was spreading information because there was nothing from the officials for an entire day.” The Post also reports that families of the hospitalized patients in Wuhan haven’t received information about their loved ones and in some cases don’t even know what hospital they are in.
Within a week of the initial outbreak in Hong Kong, at least 16 people were sick. Besides the airport and train screenings, Hong Kong health authorities have activated quarantine laws and placed all of the territory’s health facilities on high alert. Supplies of face masks have sold out, and Hong Kong nerves are on edge. One of the latest patients, a Chinese University of Hong Kong student, was removed from the dormitory on the night of Jan. 5, with photos and video of the event widely circulated on social media. Given extreme political tensions that have left Hong Kong in a state of protest for months, efforts to implement quarantine and infection control in the territory have already sparked rumors about the government’s real motives. As of Jan. 8, a bulletin put the number of cases in Wuhan at 111.
Meanwhile, in Singapore this week, a 3-year-old girl whose family had visited Wuhan over the holidays came down with severe pneumonia on returning home. Health authorities there have ruled out all known viruses and bacteria as causes of her illness and placed her in quarantine.
Alarms were also raised in Taiwan, but an alleged case of Wuhan pneumonia was misdiagnosed.
If these cases’ connection to Wuhan’s fish market are proved, and the virus that has caused this outbreak did spread from the facility, the mystery only deepens. There are no known fish viruses that cause pneumonia in humans. Bacteria, fungi, and parasites, yes—but not viruses. It is rumored, though, that the huge fish market also housed live snakes, wildlife, rabbits, and birds. The 2003 SARS outbreak began in a Guangzhou live animal market and spread from the slaughter of infected civets.
As a precaution, Wuhan authorities closed the market on New Year’s Day. Both Chinese authorities and the World Health Organization (WHO) insist that there is no evidence of person-to-person transmission of the virus (or whatever it may be), but a week after the closure of the market, new cases are appearing, their origins unexplained.
On Jan. 8 Chinese scientists informed foreign colleagues that the Wuhan pneumonia appears to be caused by a previously unknown coronavirus—a cousin of SARS and of MERS (Middle East Respiratory Syndrome), which has primarily infected people and camels in Saudi Arabia. The latest information contradicts pervious claims that the mystery virus was only 4 percent genetically akin to SARS. If this is a coronavirus disease, it is almost certainly capable of being passed from person-to-person via contact with an infected person’s saliva, nasal fluids, or uncleaned hands.
Last November, after two people were hospitalized in Beijing with pneumonic plague, Chinese officials delayed reporting the cases to WHO for more than two weeks. A number of mysteries about the illness remain outstanding, including its connection to a nearby rat infestation, reported plague cases in Mongolia, and its ultimate resolution. After a flurry of coverage in Chinese media, the story died out, government officials issued no further statements, and it isn’t known how extensive the problem may have grown.
For the latest outbreak, the conclusion of that sorry tale is the best-case scenario. The worst may be a repeat of the SARS epidemic. As early as December 2002, the Chinese government knew there was a new respiratory disease in Guangdong province but did not alert WHO or neighbor nations. When a SARS patient fled Guangzhou, crossing into Hong Kong and staying at the Metropole Hotel, nobody in the local health establishment knew anything about the virus. He stayed on the hotel’s ninth floor, where many other guests also became infected with SARS before continuing their travels, unknowingly taking the virus with them to Beijing, Hanoi, Singapore, and Toronto and thereby sparking the global outbreak.
Eventually, SARS infected and killed people all around the world. China could have prevented that tragedy but instead chose secrecy and denial. It wasn’t until April 2003 that Beijing admitted the extent of local SARS cases, prompting a mass exodus from the capital city of tens of thousands of workers, students, and the like, who carried the virus to their hometowns. Chinese health and police authorities were only able to stop the nation’s epidemic by assuming that the entire population might be sick, setting up fever check stations that anyone in the country would encounter several times a day and putting anybody whose temperature was abnormally high into hastily constructed isolation treatment units. By July 2003, WHO declared China SARS free—for the time being.
The lesson of SARS was clear: Do not cover up outbreaks. In 2005, the World Health Assembly passed the International Health Regulations (IHR), which require swift notification to WHO of any significant outbreaks, as well as transparency and global cooperation on subsequent scientific and clinical investigations. China not only agreed to the IHR but also backed Hong Kong SARS fighter Margaret Chan for leadership of WHO, where she served as director-general from 2007 to 2017.
Yet in the current outbreak, very little information of any kind has been provided by authorities in Wuhan or Beijing. China appears more interested in maintaining control by arresting those who would spread details than in abiding by the principles of the international regulations it signed. Its strategy is especially dangerous in Hong Kong, where tensions between locals and the mainland are already very high.
The Wuhan mystery illness could turn out to be something relatively benign, and all of the patients may heal and go home, no worse for wear. But that doesn’t seem likely. The more widely cases spread, and the more information that comes out about the potential virus involved, the harder it becomes to accept claims that people become infected only by contact with market fish or wildlife and the greater the concern that the illness is spreading from person to person. That makes the approaching, heavily traveled Lunar New Year holidays all the more concerning, recalling the countrywide spread of SARS by May Day holiday vacationers in 2003.
Fighting outbreaks requires trust. And trust requires openness. It is in Beijing’s own interest to regain public faith in its willingness to act as a positive force in global public health by providing swift, reliable information on disease outbreaks. It would be OK for Beijing to say, “We don’t know what it is, so be patient. We’re working on it.” It would even be OK to say, “We have no idea how this virus is spreading, but we have teams of disease detectives on the job trying to figure it out.”
But there needs to be some honest and regular communication. And it needs to start before the Lunar New Year.